In Search of the Lost Clip: Outcome of Women After Needle-Guided Lumpectomy of a Marking Clip.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
12
10
2020
accepted:
10
12
2020
pubmed:
8
3
2021
medline:
12
8
2021
entrez:
7
3
2021
Statut:
ppublish
Résumé
Needle localization of a marking clip is required to guide accurate removal of many breast lesions. When the clip is not visualized on specimen radiography, concerns regarding the completeness of cancer removal and long-term outcomes arise. Using a large cohort of women undergoing breast conservation, we examined the magnitude of the problem and the outcome of women with a missing clip. We conducted a case-control study including all women undergoing mammographic wire-guided localization between 2013 and 2018 with a specimen radiograph showing a missing clip. The control group included women with successful removal of the clip(s). Data included demographics, cancer and treatment characteristics, and outcome. The groups were compared in regard to margin status, repeat surgery, and recurrence rates. The research group included 43 women [5% of the cohort; 95% confidence interval (CI) 3.9-7.2] with a missing clip. Positive margins were comparable (7, 17% of cases; 29, 15% of 196 cases in the control group; p = 0.96). Eleven women (33%) had a residual clip visualized on post-operative mammography; in four cases, a percutaneous biopsy of the clip was successful, all with no residual tumor. There was no significant difference in re-excision rates (14% vs. 8%, p = 0.23) or in local or distant recurrence. In the majority of women with a missing clip, the clip is not visualized on post-operative mammography. Those with a residual clip can be managed with percutaneous biopsy as long as the lesion was removed with clear margins, with comparable outcomes as women in whom the clip is visualized on specimen radiograph.
Sections du résumé
BACKGROUND
BACKGROUND
Needle localization of a marking clip is required to guide accurate removal of many breast lesions. When the clip is not visualized on specimen radiography, concerns regarding the completeness of cancer removal and long-term outcomes arise. Using a large cohort of women undergoing breast conservation, we examined the magnitude of the problem and the outcome of women with a missing clip.
METHODS
METHODS
We conducted a case-control study including all women undergoing mammographic wire-guided localization between 2013 and 2018 with a specimen radiograph showing a missing clip. The control group included women with successful removal of the clip(s). Data included demographics, cancer and treatment characteristics, and outcome. The groups were compared in regard to margin status, repeat surgery, and recurrence rates.
RESULTS
RESULTS
The research group included 43 women [5% of the cohort; 95% confidence interval (CI) 3.9-7.2] with a missing clip. Positive margins were comparable (7, 17% of cases; 29, 15% of 196 cases in the control group; p = 0.96). Eleven women (33%) had a residual clip visualized on post-operative mammography; in four cases, a percutaneous biopsy of the clip was successful, all with no residual tumor. There was no significant difference in re-excision rates (14% vs. 8%, p = 0.23) or in local or distant recurrence.
CONCLUSIONS
CONCLUSIONS
In the majority of women with a missing clip, the clip is not visualized on post-operative mammography. Those with a residual clip can be managed with percutaneous biopsy as long as the lesion was removed with clear margins, with comparable outcomes as women in whom the clip is visualized on specimen radiograph.
Identifiants
pubmed: 33677760
doi: 10.1245/s10434-021-09800-7
pii: 10.1245/s10434-021-09800-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4974-4980Informations de copyright
© 2021. Society of Surgical Oncology.
Références
Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005;353(17):1784–92.
doi: 10.1056/NEJMoa050518
Tabar L, Duffy SW, Vitak B, Chen HH, Prevost TC. The natural history of breast carcinoma: What have we learned from screening? Cancer. 1999;86:449–546.
doi: 10.1002/(SICI)1097-0142(19990801)86:3<449::AID-CNCR13>3.0.CO;2-Q
Leitch AM, Dodd GD, Costanza M, et al. American Cancer Society guidelines for the early detection of breast cancer: update 1997. CA Cancer J Clin. 1997;47:150–3.
doi: 10.3322/canjclin.47.3.150
Kerlikowske K. Efficacy of screening mammography among women aged 40 to 49 years and 50 to 69 years: comparison of relative and absolute benefit. J Natl Cancer Inst Monogr. 1997;22:79–86.
doi: 10.1093/jncimono/1997.22.79
Corsi F, Sorrentino L, Bossi D, Sartani A, Foschi D. Preoperative localization and surgical margins in conservative breast surgery. Int J Surg Oncol. 2013;2013:1–9.
doi: 10.1155/2013/793819
Kopans DB. Preoperative imaging-guided needle placement and localization of clinically occult breast lesions. AJR Am J Roentgenol. 1989;152:1–9.
doi: 10.2214/ajr.152.1.1
Frank HA, Hall FM, Steer ML. Preoperative localization of nonpalpable breast lesions demonstrated by mammography. N Engl J Med. 1976;295:259–60.
doi: 10.1056/NEJM197607292950506
Burbank F, Forcier N. Tissue marking clip for stereotactic breast biopsy: initial placement accuracy, long-term stability, and usefulness as a guide for wire localization. Radiology. 1997;205(2):407–15.
doi: 10.1148/radiology.205.2.9356621
Calhoun K, Giuliano A, Brenner RJ. Intraoperative loss of core biopsy clips: clinical implications. Am J Roentgenol. 2008;190(3):W196–200.
doi: 10.2214/AJR.07.2569
Rosen EL, Baker JA, Soo MS. Accuracy of a collagen-plug biopsy site marking device deployed after stereotactic core needle breast biopsy. AJR Am J Roentgenol. 2003;181(5):1295–9.
doi: 10.2214/ajr.181.5.1811295
DiPiro PJ. Disappearance of a localizing clip placed after stereotactic core biopsy of the breast. AJR Am J Roentgenol. 1999;173(4):1134.
doi: 10.2214/ajr.173.4.10511199
Baker DR, Reynolds HE, McGraw P. Percutaneous extraction of a biopsy-site marker clip using a vacuum-assisted biopsy device. AJR Am J Roentgenol. 2000;175(4):1051–2.
doi: 10.2214/ajr.175.4.1751051
Brenner RJ. Percutaneous removal of postbiopsy marking clip in the breast using stereotactic technique. AJR Am J Roentgenol. 2001;176(2):417–9.
doi: 10.2214/ajr.176.2.1760417